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Medical students and physicians share their writings on “becoming a real doctor”

Medical students and physicians share their writings on "becoming a real doctor"

louisewenreading_CROPPEDThe dilemma of being a medical student on clinical rounds who wants to help patients but can’t was captured by third-year student Raymond Deng in his essay “Performing Grief,” at a recent reading held by Stanford’s Medicine and the Muse Program and Pegasus Physician Writers group.

The event, titled “Becoming a Real Doctor: Writings on Medical Education and Training,” also featured a poetry reading by fourth-year medical student Lauren Pischel, a book excerpt by Cornell physician Matt McCarthy, MD, and essay readings by Emily Liu, a second-year medical student, and Louise Wen, MD.

The audience of medical students, physicians, residents, nurses and community members listened attentively as Deng described what it can feel like to be a medical student:

For a year or two, you will inch your way on the tightrope towards white-coated authority from diligently reproduced sham. What you lack in clinical knowledge, you will compensate for with the appropriate attire. Be meticulous. Put on your requisite, freshly-pressed white coat. Hang your stethoscope across the nape of your neck. Cram the pockets of your white coat so full of notes and reference guides that they sag. Ignore the nagging incongruence: the fact that you’re not a doctor but you look like one. You want to help patients, but will settle for watching… You will feel like a cardboard marionette, dancing to the steady rhythm of acting competent and acting ignorant of your acting.

For Wen, it was acting against the rules of eating in the area of clinical care that afforded her the opportunity to connect with her patient, Sara, on a personal level:

Hey doc, here’s a treat for you, I know you guys work hard… Here, try some Afghani bread.” She looks up, eager to connect, and my own yearning to know this women beyond her illness swells within my chest. I can recite numerous details and data points about her medical history and hospital course, but her life as a human being is a gaping void.”

Eating the homemade bread, with “the inside as soft as pillowy sponge cake,” led to a sharing of photographs of Afghanistan and a filling of the void for Wen.

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Events, Medicine X

Stanford Medicine X, in pictures

Stanford Medicine X, in pictures

We’ve written extensively over the last six days about Stanford Medicine X and its sister conference, Stanford Medicine X | ED; you can see all the coverage in this category. And now, one last look at what transpired here.

More photos of Stanford Medicine events, people and places can be found on Instagram

Photos courtesy of Stanford Medicine X

Chronic Disease, Events, Medicine X, Sexual Health

A discussion of intimacy and illness at Medicine X: “Embrace yourself and embrace your normal”

A discussion of intimacy and illness at Medicine X: "Embrace yourself and embrace your normal"

21735972186_ef347da42d_zMedicine X is well known for shining a light on dark feelings and difficult-to-talk about topics, as well as being a safe place to hold such conversations within the health-care community. Last year, a key theme of the conference was addressing the relationship of mental and physical health. The discussion of treating the whole person, not just their disease or symptoms, was expanded this year to include sexual health.

In a Sunday session exploring intimacy and illness, Medicine X executive board member and well-known patient advocate Sarah Kucharski bravely spoke about her own relationship experiences as she led the discussion. “Illness completely changes one’s relationship with one’s body. It’s the idea of feeling broken. Of feeling you’re a burden. Of feeling not sexy,” she said.

Diagnosed at the age of 31 with intimal fibromuscular dysplasia, Kucharski has undergone multiple surgeries, resulting in permanent scarring of her body. She shared with the audience her anxiety over romantic partners seeing the scars for the first time during intimate moments and suddenly having to answer their questions. She said, “To expose that visual reminder of my health, maybe it’s too much. Maybe it’s forcing me to be who I really am instead of enjoying a certain escapism,” she said. “It takes away my opportunity to talk about my health.”

Many patients and caregivers can relate to Kucharski’s struggle with intimacy and illness. She conducted an informal online survey in preparation for the conversation. The biggest finding? There is no normal. But this reality often isn’t conveyed in doctor-patient conversations. For patients who undergo a medical procedure or women who give childbirth, physician advice is usually to wait for a certain period of time until they are physically healed and then resume sexual activity “when they feel ready.”

Matthew Dudley, MD, a hospitalist who works in Alaska, said one of the factors driving the lack of doctor-patient communication about sexual health is that “health care in this country is reactionary.” He added, “We end up dealing with this emergent actions, and so you don’t get time to sit down and talk about these issues.”

In addition, pointed out panelist Alexandra Drane, the medical education curriculum at many institutions doesn’t dedicate enough time to sexual health issues. Beyond expanding the training of future doctors, she advocated for “normalizing the conversation” about intimacy. “This is a topic that most people really, really want to talk about. There needs to be training [for doctors] on how to have these conversations and how to make someone feel safe and normal,” said Drane, co-founder of the Eliza Corporation.

But more training for medical students may not to be the silver bullet that resolves the problem, say some panelists. Dudely said he received a full two weeks of training on sexual health issues during medical school. “I thought at my school we did a good job,” he said, “But in the day to day it gets lost. We need patients to go to their doctors and say, ‘I want to know more about this.’ As our culture becomes more open about these issues, I think it will come to the forefront.”

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Events, Medicine X, Technology

From patient to entrepreneur: Three Medicine X panelists offer advice

From patient to entrepreneur: Three Medicine X panelists offer advice

patient panel

“Who better than to solve our problems in health care than the people who live it and breathe it every day?” That was the rhetorical question posed by Darla Brown, a panelist in a Saturday Medicine X session on patients as entrepreneurs. Brown, a cancer patient who co-created digital health company Intake.Me, and her two co-panelists, Molly Lindquist and Michael Seres, talked about how they took their health-related ideas from concept to reality and offered advice for the other big thinkers in the audience. Among the points made during their 45-minute session:

-Do your due diligence: As noted by Seres, a prolific patient blogger who founded the health tech start up 11Health, “there are thousands of patients who are solving real problems every day” but there may not be a widespread need for such solutions. In other words, a product or service that is helpful to one patient may not be appealing to many others. “Make sure you’re not the one person who wants this end solution,” said Lindquist, a breast cancer survivor and founder of Consano, a nonprofit crowdfunding platform for medical research.

-Talk, talk and talk some more: When exploring the validity of an idea, pick up the phone or hit the keyboard. “You don’t need to do big market research – just talk with other patients,” advised Brown. Lindquist agreed, noting that when she was thinking of starting Consano she reached out to numerous people in her professional and personal life. (She joked that when her number comes up on her friends’ cell phones these days, they likely think, “Oh, what does she want now?”) She said the ensuing conversations “helped vet the idea and the potential issues and benefits that would come from creating an organization.”

-Be able to communicate your product and its need: Especially when working with potential investors or donors, “being really solid in your mission and intent and being able to communicate that” is key, said Lindquist. Seres shared with the audience that his first investor gave him only a “tiny bit of money” and wanted Seres to show him he could be successful on a larger scale. “Ultimately you have to prove the business model and be clear on who your target audience is and whether [your idea] is big enough,” he said.

-Know there will be challenges: “I’ve been patient for more than 30 years. I felt I knew everything about my condition and my health and my journey,” but navigating the business world was a whole different ballgame, Seres said. (He later noted that he still doesn’t think of himself as founder of a technology company: “I’m just a patient providing a solution for a problem no one else” was working on.) But patients have resilience, he pointed out, and “given what you’re dealing with on a daily basis nothing is impossible.” Brown also offered the practical tip of reading The Business Model Generation, which she and Emily Lu, MD, (the panel’s moderator) consulted before starting Intake.Me.

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Events, Medicine X, Patient Care, Technology

At Medicine X, designers offer their take on why patient-centered design is top priority

At Medicine X, designers offer their take on why patient-centered design is top priority

Aaron Sklar at MedXAs a Medicine X veteran, I’m used to hearing patients talk about the importance of putting patients’ needs first. But yesterday afternoon, I got to hear about patient-centered design from designers.

At a session called “Fulfilling the promise of technology in health through human centered design,” Joan Saba, an architect who designs hospitals for NBBJ, used a personal story to illustrate how good design is essential to patient care. Her mother recently became sick and needed to stay at the hospital overnight, and “this is where she spent 24 hours,” she said. Sounds of ambulances wailing and doors slamming filled the lecture hall while an image of a bed surrounded by electrical cords and medical equipment lit up the screen. “Her room was right above the ambulance bay,” Saba explained.

With recent advances in technology, hospital rooms don’t need to look, sound or feel like this, said Saba. “So, what should a patient’s room look like now?” It being a calm place (unlike her mom’s room) is important, but there are other considerations, too: “Now we are thinking about it being a place for learning and information exchange.”

This desire to think about such an exchange, and improved doctor/patient communication, was echoed in the talk by Marc Katz, MD, MPH, chief medical officer of the Bon Secours Heart & Vascular Institute. He told the story of meeting patient-advocate Sarah Kucharski, who has the rare disease fibromuscular dysplasia and has endured many medical procedures, including a triple bypass surgery, back at the first Medicine X. “I go to several media conferences a year, and this was the first time I’d seen a patient present,” he recalled. “This was an eye-opening experience.”

Hearing about what Kucharski went through, prompted Katz to start querying other patients about their cardiac surgeries. “The biggest problem was communication — patients didn’t feel they understood what was happening [while at the hospital],” Katz said. So he helped develop Co-Pilot, a program that assigns a personal nurse to each patient. The program is still in its early stages but it seems to be paying off, Katz said: In a sample of about 150 patients, the Co-Pilot program reduced the duration of hospital stay and readmission, also, patients reported greater satisfaction.

After a talk from pain management expert Frank Lee, MD, on a project he started to increase transparency about the way patients’ prescription narcotic use is tracked and to hopefully, in turn, curb prescription painkiller abuse, speaker Aaron Sklar closed things off with a provocative statement. Sklar, managing director at Healthagen and co-founder of Prescribe Design, suggested it may be “time for technology to fade into the background.” What he meant is that it is the patient, not technology, that should be at the center of health-care design. “Actually we just coined a new term to describe this,” Sklar said. “D-patients: Patients that design.”

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Sklar courtesy of Stanford Medicine X

Big data, Events, Health Costs, Health Policy, Medicine X

Peter Bach on drug pricing: “A system so broken even a child could manipulate it”

Peter Bach on drug pricing: “A system so broken even a child could manipulate it”

Peter Bach at MedX

The U.S. medical system is like a New England toll road: It’s designed to extract tolls from patients all along their health-care journeys, with a callous disregard for whether or not these travelers arrive at their desired destination, a place of better health.

This was the angry message delivered by Peter Bach, MD, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes, who was the keynote speaker at today’s Medicine X conference.

Dr. Bach is a physician, an epidemiologist, a researcher and a respected health-care policy expert whose work focuses on the cost and value of anti-cancer drugs. He was also a caregiver who has traveled down the patient side of the system as his wife died of cancer.

In his talk, Bach discussed three of the major toll takers in the system — pharmaceutical companies, hospitals and researchers — and how the public’s wielding of a growing body of health-care data could be used to reign in a process that is driven more by profit than health outcomes.

This week no discussion on escalating health-care costs could pass without mentioning Martin Shkreli, the 32-year-old hedge fund manager whose drug company raised the price of a decades-old anti-parasite drug by more than 5,400 percent. “He made it clear that the system is so broken even a child could manipulate it,” said Bach.

But Bach went on to show some promising quality improvement projects that are helping to bring accountability into the health-care system.

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Events, Medicine X, Patient Care, Precision health, Public Health

At Medicine X, talking about owning one’s data and about patient-tailored health care

At Medicine X, talking about owning one's data and about patient-tailored health care

Matthew Might on stage - 560Health care that’s tailored to you and taking ownership of your health data were the themes of the morning yesterday at Medicine XLloyd B. Minor, MD, dean of the medical school, got the conversation rolling by defining precision health, and in a session that followed, several speakers shared stories that illustrated various aspects of this area.

In a presentation cleverly called “Can medical ‘selfies’ save us?” Steven Keating, a graduate student at MIT, began by explaining to attendees why it’s important to monitor your own health. Several years ago doctors detected a slight abnormality in Keating’s brain; they told him to “monitor it” and he took this advice to heart. He requested copies of his medical records, learned about the brain and paid close attention to how he was feeling, he explained. “Then I started smelling whiffs of vinegar,” he said.

Keating urged doctors to conduct an MRI and discovered he had a brain tumor (about the size of a lemon) that would need to be surgically removed. Keating told the audience that his interest and engagement in his own health care wound up saving his life.

Next, Claudia Williams, senior advisor for health innovation and technology at the White House Office of Science and Technology Policy, took the stage to discuss the Precision Medicine Initiative that was launched this January by President Obama’s Administration. The initiative, she said, is “about moving away from the one-size fits all approach and moving toward one that tailors [care] to your specifics.” To do this, the National Institutes of Health is now inviting people to join a cohort of one million individuals (or more) that will contribute biological samples and data to advance researchers’ understanding of heath and disease.

Many people have said they would participate in this initiative if they could get their own medical records back, Williams said. “Building trust and accountability” is a key part of this initiative, she said, noting that “If you want encrypted email data, you have the right to it.”

Having access to data from this initiative, especially genomic data, could help patients learn which drugs will be most effective for them and help people with rare diseases learn more about their illness, Williams told me during a post-panel interview.

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Aging, Events, Medicine and Society, Medicine X, Stanford News

Living long and living well: A conversation on longevity at Medicine X

Living long and living well: A conversation on longevity at Medicine X


There were big-time laughs, and the expected misty eye or two, at today’s Medicine X session on aging and longevity. Natrice Rese, a retired personal support worker, began the conversation with a moving ePatient Ignite! talk about how life for many older adults is less than “golden.” She told the audience how difficult time spent in a nursing home or care facility can be: “So many people wait to be fed, wait to be dressed, wait to be undressed, wait to be taken outside… When you’re dependent on care from others, your life is reduced to a waiting game.”

Her mother found herself in one such place at the age of 85, and Rese recalled how her mom pulled her aside one day and said, “Don’t come near these places – it’s not good here.” Her mother was in the throes of Alzheimer’s and unable to offer further details, but “her words stay with me today,” Rese somberly told the audience.

Rese said her mom’s comments ultimately reinforced her desire to work to make sure older adults feel appreciated and are able to “create memories that matter.”

Fellow panelist Barbara Beskind is certainly doing that – and more. The 91-year-old former occupational therapist made headlines when she landed a job at Silicon Valley design firm IDEO. Appearing at the conference alongside Dennis Boyle, a partner and founding member of the firm, she goes to the office every Thursday and is now working on a variety of projects related to aging – including a redesigned walker.

Younger designers “can’t put themselves in the shoes of the elderly,” Beskind told USA Today earlier this year. “People who design for the elderly think they need jeweled pill boxes or pink canes. We need functional equipment.”

“I admire you,” Rese told Beskind during a panel discussion, after hearing about Beskind’s contributions. “You shouldn’t be one of a few – you should be one of many.”

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Events, Medical Education, Medicine X, Stanford News

Learning from patients by walking in their shoes

Learning from patients by walking in their shoes

digital storytelling workshopWhere else but at a medical conference in Silicon Valley would you hear the term “empathy hack”? The concept of the empathy hack unites the acknowledged need for education geared toward fostering empathy in health-care providers with the innovative, disruptive mentality of the valley. The result is “One Day,” a pilot project led by Rice University’s Kristen Ostherr, PhD, and Roni Zeiger, MD and CEO of, who shared their hacking concept with attendees at a Stanford Medicine X | ED workshop yesterday.

The concept behind “One Day” is to pair a patient and a learner (a medical student, doctor, researcher, hospital administrator, or educator) and have the learner experience a day in the life of that patient, with everything that entails, including self-treatments and physical challenges caused by the patient’s illness.

The learner receives a “kit” containing materials that simulate the condition of the patient for the learner, i.e.  a thin straw and air pack to simulate a nebulizer used by patients with cystic fibrosis, or leg weights to be worn to simulate the drag caused on limbs by Parkinson’s disease.

Once patient and learner are matched, they agree on a form of communication for the day, with modalities including SMS Text, Facebook chat or texting with video, audio and photographs. The learner then follows the actions of the patients during the day, whether administrating nebulizer treatments or trying to negotiate crossing a street quickly with limbs that are weighed down.

After describing the project, Ostherr and Zieger asked attendees to brainstorm ideas for expanding this model to be used for other patient illnesses and experiences. Participants in the outdoor workshop were doctors, patients and medical educators, and their responses included chronic pain, diabetes, homelessness patients, and palliative care and end of life treatment. Caroline Okorie, MD, a Stanford pediatric pulmonologist, said she would like to see an exercise like this for teenagers dealing with CF: “They really have a unique issues, even in comparison to adults.”

A patient who has been dealing with chronic pain for years suggested that learners should deal with multiple challenges, as many patients do. “It may not just be that the pain is your back, that can lead to shoulder pain, or headaches, and all this happens at once.”

Zieger and Ostherr, who hope to bring the project to medical schools, emphasized the simplicity of the model: The kits cost approximately $30, and HIPPA concerns are handled by informed consent filled out by the patient participants. It’s small investment for the potentially-eye opening and revelatory experience of health-care providers walking in the shoes of a patient, even just for a day.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Kristen Ostherr and Roni Zeiger (both standing) courtesy of Stanford Medicine X

Events, Medical Education, Medicine X, Patient Care, Precision health, Technology

“No ordinary conference”: The magic that is Medicine X returns to the stage

"No ordinary conference": The magic that is Medicine X returns to the stage

Larry Chu welcoming attendeesMedicine X, Stanford’s popular conference on emerging technologies and medicine, returned to the stage today.

The conference, which was proceeded by the first-ever Medicine X | Ed, is now in its fourth year, and the momentum and magnitude of the event has steadily increased since it began.

Last year, more than 4,000 participants in 69 countries took part in the Medicine X experience via Twitter, making it the most-discussed academic conference in the world. Its past successes were reflected in the theme for Medicine X 2015: “Great Xpectations.”

After executive director Larry Chu, MD, welcomed attendees with a reminder that they “all belong here,” Lloyd B. Minor, MD, dean of the medical school, officially opened the conference with remarks that encouraged this engaged audience to take action and seize opportunities to improve health care. “This is no ordinary time in our history, and Medicine X is no ordinary conference,” he said. “We are here today to have discussions and generate ideas about how to leverage the power of information and the latest technology to improve health for people in our own communities and across the globe. Health care is truly the opportunity of our lifetime.”

Minor talking“Since last year’s Medicine X conference, Stanford Medicine has launched a bold new initiative — our vision to lead the biomedical revolution in precision health,” he said. “Precision health as the next generation of precision medicine: Precision medicine is about sick care, precision health is about health care.” Everyone participating in this event is an important part of moving this conversation forward, he explained.

Eric Topol, MD, chief academic officer at Scripps Research Institute and bestselling author, went on to give an opening keynote on ways we can use new technologies to democratize medicine and involve the patient in his or her own care. “We have views of the human being that we never had before,” Topol said, referencing smartphones and other technologies that people use to monitor their health metrics.

These new technologies are important because they’re interactive and easy for patients to use, and they allow patients to become more involved in their health care, Topol explained. He showed an image of the iconic black doctor’s bag. “These are vintage tools,” he said. “This is my bag,” he explained, pointing to an image of a several digital tools.

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